ABSTRACT
Abstract Distal radial fractures are very common. Vicious consolidation can occur in up to one third of these fractures, resulting in wrist pain, restricted movement, and, eventually, physical limitation or disability. The treatment of this condition consists in corrective osteotomy, which requires careful preoperative planning due to its three-dimensional complexity, especially in injuries with joint involvement. Recently, prototyping based on three-dimensional (3D) reconstruction of computed tomography (CT) scans has been used for osteotomy planning in a 3D anatomical model. It allows a better understanding of the deformity in a realistic surgical approach, leading to safer, faster, and more predictable procedures. The aim of the present study is to present this technique and show its use in two clinical cases.
Resumo As fraturas da porção distal do rádio estão entre as mais comuns do esqueleto. A consolidação viciosa pode ocorrer em até um terço dessas fraturas e acarretar restrição de movimento e dor no punho, com consequente limitação ou incapacidade laboral. O tratamento desta condição implica em osteotomia corretiva das deformidades, o que necessita de um planejamento pré-operatório criterioso em virtude de sua complexidade tridimensional, notadamente naquelas em que há acometimento articular. Assim, recentemente, tem sido utilizada a prototipagem a partir da reconstrução 3D da tomografia computadorizada (TC), o que permite o planejamento com realização da osteotomia em modelo anatômico tridimensional, com o melhor entendimento da deformidade, aproximando-se da situação realística da cirurgia, o que torna o procedimento mais seguro, ágil e previsível. O objetivo do presente estudo é apresentar esta técnica e seu emprego em dois casos clínicos.
Subject(s)
Humans , Male , Female , Middle Aged , Osteotomy , Radio , Tomography, X-Ray Computed , Fractures, Bone , Printing, Three-Dimensional , Models, AnatomicABSTRACT
BACKGROUND: Various deformities can occur in the forearm bones when the traumatically dislocated radial head is untreated for a long period. Without correction of all deformities, reduction of the dislocated radial head is difficult to maintain, and forearm and elbow motion will deteriorate after reduction. We evaluated radiographic parameters of forearms with traumatically dislocated radial heads (and of the normal sides) to understand the resulting deformities and the effectiveness of surgical treatment. METHODS: We analyzed pre- and postoperative anteroposterior and lateral radiographs of 22 forearms (22 patients) with traumatic radial head dislocation. We divided the forearm into three equal parts and measured various morphological parameters. All patients underwent surgical treatment and evaluation of radial head reduction and range of motion pre- and postoperatively. RESULTS: Before treatment, the middle of the ulna was significantly different from the unaffected side in both anteroposterior and lateral views. After surgery, the proximal ulna was significantly different from the unaffected side and the abnormal proximal radial neck angle persisted. The radial head was successfully reduced in 20 of 22 cases. Overall, the mean range of motion decreased after surgery, except for increased flexion-extension. CONCLUSIONS: Complicated deformities developing during long-term remodeling after injury indicate that stable reduction is difficult to achieve with conventional one-bone osteotomy. Even after successful reduction, secondary deformity in the proximal ulna and/or remaining deformity in the proximal radius can hinder forearm rotation.